Thread by @LaurenWeberHP

Did you know your insurer can tell you something is covered, and then after you have surgery say they’re not going to pay for it?

And yes, it’s legal.

Welcome to American health care in 2020.

My latest @KHNews for @USATODAY : usatoday.com/story/news/hea…

This practice, which has left patients with thousands of dollars of bills, is called “retrospective denial.”

Essentially, insurers will give prior authorizations, a type of preapproval growing in number, for surgeries, medicines or tests.

You, the patient, think you’re covered.

But little do you realize those prior authorizations are not a guarantee.

Insurers can change their minds after the fact — citing treatments as medically unnecessary upon further review, blaming how billing departments charged for the work or claiming the procedure was performed too long after approval was granted.

In other cases, a patient or provider will be told that no prior authorization is needed for certain intervention, only to hear afterward that the insurer wanted one in this particular case.

It then refuses to pay.

Darla Markley told me how she was approved for tests at the Mayo Clinic, which helped diagnose her with a rare disease.

Then, as so often happens in the gothic horror that is the broken American health care system, the bills came.

She and her husband lost their home after their insurer refused to pay for tests it had said it would before she had them.

That was all it took to knock them out of the middle class.

“I wish people would understand that they are one illness away from totally losing everything they worked for,” Markley said. “I lost it all in a day.”

Has this happened to you or do you work in a provider’s office dealing with this? I want to hear more about it. Reply to this thread or DM me with your prior authorization retrospective denial story.

usatoday.com/story/news/hea…